The Journal of Practical Medicine >
Prognostic value of combined preoperative MRI and postoperative pathological assessment of lymph node metastasis in rectal cancer patients
Received date: 2023-12-25
Online published: 2024-06-13
Objective To investigate the value of combining preoperative magnetic resonance imaging（MRI） and postoperative pathological assessment of lymph node metastasis in predicting overall survival in rectal cancer patients. Methods This retrospective study collected clinical， pathological and image information of 2610 patients histopathologically confirmed with rectal adenocarcinoma at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2016 and December 2021. All patients underwent MRI scans and were divided into three groups according to lymph node status assessed by preoperative MRI（ MRI N） and postoperative pathology（ P N）： MRI N+ but P N-（ MRI N+ group）， P N+ but MRI N-（ P N+ group）， MRI N+ and P N+（ MRI-P N+ group）. Inverse probability weighting（IPW） was used to adjust for confounding factors. Kaplan-Meier curves were used to estimate overall survival and log-rank tests were used to compare the difference. Univariate Cox regression models were used to analyze the correlation between tumor characteristics and overall survival， and bidirectional stepwise Cox regression models were used to identify independent risk factors for overall survival. Results The MRI-P N+ group showed higher tumor staging， more frequent perineural invasion， more distant metastases， and a higher risk of death compared to the P N+ group and MRI N+ group（all P < 0.05）. Kaplan-Meier curves showed that the 3-year survival rates for the MRI N+ group， P N+ group， and MRI-P N+ group were 90.5%， 79.1%， and 76.4%， respectively； the 5-year survival rates were 85.7%， 71.5%， and 59.2%， respectively. Stepwise Cox regression showed that age， tumor location， carcinoembryonic antigen， carbohydrate antigen 19-9， lymph nodes number， pathological tumor stage， lymphovascular invasion， perineural invasion， distant metastasis， neoadjuvant therapy and adjuvant therapy， and MRI-pathology lymph node status were independent risk factors for overall survival in rectal cancer（all P < 0.05）. Conclusion Evaluating the lymph node status by combining preoperative MRI and postoperative pathology helps predict overall survival in rectal cancer patients more accurately.
Key words： rectal cancer; MRI; lymph node; prognosis
Zhiming ZENG , Pan ZHU , Decai MA , Xiaohui DI , Guiting LI , Wenbin ZHOU , Ximin. PAN . Prognostic value of combined preoperative MRI and postoperative pathological assessment of lymph node metastasis in rectal cancer patients[J]. The Journal of Practical Medicine, 2024 , 40(11) : 1560 -1567 . DOI: 10.3969/j.issn.1006-5725.2024.11.016
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